Wednesday, July 07, 2010
Obama's Unconfirmed 'Recess' Appointee to Run Medicare Advocated Rationing, Redistribution of Wealth
...Berwick is known for his staunch defense of Great Britain’s government-run National Health System (NHS)—which he has hailed as a model for the world-- and his penchant for comparing the U.S. health-care system unfavorably to the British system.
In the July 26, 2008 issue of the British Journal of Medicine (BMJ), Dr. Berwick published an article praising the NHS on its 60th birthday and urging Great Britain to reject free enterprise in health care. In the United States, he argued, competition among rival health-care providers had produced an excess supply of health care.
“Please don’t put your faith in market forces,” he said (italics in original). “It’s a popular idea: that Adam Smith’s invisible hand would do a better job of designing care than leaders with plans can. I find little evidence that market forces relying on consumers choosing among an array of products, with competitors fighting it out, leads to the healthcare system you want and need. In the US, competition is a major reason for our duplicative, supply driven, fragmented care system.”
Berwick argued that purposely provided an inadequate supply of health-care—as Britain’s health-care system does—is superior to allowing the market to provide an excess.
“In America, the best predictor of cost is supply; the more we make, the more we use—hospital beds, consultancy services, procedures, diagnostic tests,” Dr. Berwick wrote. “… Here, you choose a harder path. You plan the supply; you aim a bit low; you prefer slightly too little of a technology or a service to too much; then you search for care bottlenecks and try to relieve them.”...
...When the interviewer for Biotechnology Healthcare said to Dr. Berwick that critics had said that federal Comparative Effectiveness Research would “lead to rationioning of healthcare,” Berwick responded: “We can make a sensible social decision and say, ‘Well, at this point, to have access to a particular additional benefit [new drug or medical intervention] is so expensive that our taxpayers have better use for those funds.’ We make those decisions all the time. The decision is not whether or not we will ration care — the decision is whether we will ration with our eyes open. And right now, we are doing it blindly.”
In his BMJ article celebrating the 60th birthday of Britain’s government-run National Health System, Berwick said: “Cynics beware, I am romantic about the National Health Service; I love it. … The NHS is one of the astounding human endeavours of modern times.”
Berwick expressed his belief that it was important for the NHS to continue because it was the model health-care system for the world.
“The only sentiment I feel for the NHS that exceeds my admiration is my hope,” he said. “I hope you will never, ever give up on what you have begun. I hope you realise and reaffirm how badly you need—how badly the world needs—an example at scale of a health system that is universal, accessible, excellent, and free at the point of care—a health system that, at its core, is like the world we wish we had: generous, hopeful, confident, joyous, and just. Happy birthday.”...
